ER boarding crisis reform attracts opposition

·3 min read

Jun. 8—CONCORD — Hospital, social service and disability rights leaders on Tuesday opposed the Sununu administration's bid to increase the time someone could wait in an emergency room to be evaluated for mental illness.

After a two-hour public hearing, a key State Senate committee unanimously rejected the amendment to an unrelated bill (HB 565).

Senate Majority Leader Jeb Bradley, R-Wolfeboro, urged Health and Human Services Commissioner Lori Shibinette to convene a working group to find common ground.

Three weeks ago, the state Supreme Court ruled the state was in violation of the state law that requires patients waiting in hospital emergency rooms to receive a due-process hearing within three days.

The plan Shibinette offered would have allowed the state to have three extra days to place someone in "medical protective custody" to determine whether a patient should be involuntarily admitted to a mental health hospital treatment bed.

Shibinette said this solution is needed because 25% of those who end up in the emergency room are ultimately not admitted to a mental hospital. That's because many of these patients do not suffer from mental illness but have medical problems such as substance abuse, dementia or a developmental disability.

"We have had an ER (emergency room) boarding crisis for 10 years. It is time to fix it, not talk about fixing it," Shibinette said.

Since the court ruling, Shibinette said the state took action to reduce the wait list of adults in emergency rooms awaiting a mental health treatment bed.

The operators of long-term care centers agreed to take 25 patients from the New Hampshire Hospital and place them in their own geriatric units with the offer of incentive pay, Shibinette said.

In addition, the state temporarily converted a 10-bed unit in the state hospital from a wing for children to treatment beds for adults.

As a result, state officials on Monday announced no adults were on the waiting list for treatment.

Gilles Bissonnette, legal director for the American Civil Liberties Union of New Hampshire, said the administration's proposal would increase the time patients are in emergency rooms waiting for care.

"I am pleased with the news about the waiting list for adults, but my fear has always been we are going to have it in the future," Bissonnette said.

Involuntary commitment

Michael Skibbie of the Disabilities Rights Center said the law requires a judge to make the decision about an involuntary commitment, not a doctor.

"We left behind a system of involuntary medical confinement based on a medical provider half a century ago," Skibbie said. "We can't abandon that."

Steve Ahnen, president of the New Hampshire Hospital Association, said hospital executives had explored whether to hold the due process hearings in a hospital setting.

Hospital leaders decided this could not be done safely, Ahnen said.

"We continue to believe that is a barrier we are unable to get beyond," Ahnen said.

Gary Apfel was the lawyer representing the patient known as "Jane Doe," who convinced the Supreme Court to make its ruling.

"The issue is whether or not someone is being detained against her will without any opportunity to challenge that through an independent person," said Apfel, who urged the Senate committee to reject the plan.

Shibinette said another provision of her amendment would allow the state to contract with a "private entity" that could expand mental health treatment capacity beyond the network of community mental health centers.

Bradley said the Senate panel will continue discussions about the topic that could result in legislation next year.